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Few people seem comfortable with the idea of paying patients to do what we want them to do. That’s unfortunate, because there’s a significant amount of research that says this works. I’m not talking about things like wellness programs, which offer reductions in insurance premiums if you do what your employer wants. Those are really a means of cost-sharing in which expenses are shifted onto people who are less healthy. I’m talking about paying incentives directly to people in exchange for changes to their behavior or health. (Aaron E. Carroll, 7/6)

Sometimes, it's good to be unfriendly. California's hostility toward smoking — it was the first to ban smoking in public indoor spaces, and many municipalities have made it illegal in certain outdoor venues as well — has helped give the state the second-lowest smoking rate in the nation (behind Utah). The question is how to push that number still lower than the current rate of less than 12% without trampling on the individual's right to make the unwise, unhealthful decision to smoke. Two bills before an Assembly committee on Wednesday share the worthwhile aim of fighting the nicotine habit, but both have flaws. (7/6)

When President Obama signed the Affordable Care Act (ACA) in 2010, millions of Americans received prescription drug coverage as part of their new health insurance. While this expanded coverage provided new access to prescription drugs for many Americans, it brought with it additional pharmacy requirements for both states and the federal government. Fast-forward to five years later and those ACA requirements are putting a heavy strain on state Medicaid programs as they work to manage pharmacy benefits for an increasingly diverse beneficiary population and an increasingly expensive array of drugs. (Bruce Caswell, 7/6)

A disproportionate share of U.S. health care spending is focused on a relatively small number of people, many with multiple chronic diseases. This is especially true for Medicaid, the health insurance program for people with low income. Just 5 percent of Medicaid beneficiaries account for more than half of all Medicaid spending, and 1 percent account for 25 percent of total spending, according to an analysis of national Medicaid spending. So, if you want to improve health outcomes for Medicaid recipients and hold the line on state Medicaid spending, it makes sense to improve care for high-cost, high-needs patients, many of whom live in New Jersey’s poor, urban communities. (Joan Randell, 7/6)

Patients today are demanding that their physicians communicate quickly and effectively with each other. They expect referrals to be sent electronically and their medical history and personal data to be at their physicians’ fingertips. Ideally, these communications would flow through one easy-to-access, universally available, completely private channel. Making this a reality is a tall order, but one that health care professionals are taking seriously. The wide adoption of electronic medical records over the past 10 to 15 years is an important step forward in making information more readily accessible. However, if a medical practice or a hospital begins to use electronic medical records, their system may not be capable of sharing this information with other physicians or hospitals – and that’s a serious problem. (Elizabeth A. W. Williams, 7/6)